Development intensity and incident stroke risk: a longitudinal study of the REGARDS cohort.

Stroke risk may be affected by the level of development in a neighborhood, which may in turn affect access to health-promoting environmental features, or exposure to noise and air pollution. This study investigated development intensity as a potential influence on stroke risk, using data from the United States Geological Survey National Land Cover Database (NLCD). We tested associations between development intensity and incident stroke among 25,330 adult participants in the REasons for Geographic And Racial Differences in Stroke study. We measured development intensity in 8-km network buffers around participants' residential locations (34,368 locations). A proportional hazards model controlled for demographic characteristics and stroke risk factors. Approximately half (52.0%) of the participants were 45 to 64 years of age, 54.9% were female, and 40.2% reported their race as Black. Median time in the study was 10.7 years. Average development intensity at baseline was -2.9. During the 2003 to 2017 study period, 1319 participants (5.2%) had an incident stroke. Exposure to greater development intensity was associated with reduced incident stroke risk (HR 0.975, 95% CI: 0.95-0.99). This study demonstrated the influence of development intensity on stroke risk. Further work is needed to understand the specific environmental features by which development intensity affects stroke risk.